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HUMAN SEXUAL DEVELOPMENT AND PARAPHILIAS. Prof. MUDr. Jiří Raboch, DrSc. Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague. sexual sexual deviations delinquents. deviant sexual delinquents. SEXUAL DEVELOPMENT.

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human sexual development and paraphilias

HUMAN SEXUAL DEVELOPMENT AND PARAPHILIAS

Prof. MUDr. Jiří Raboch, DrSc.

Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague

slide2

sexual sexual

deviations delinquents

deviant sexual

delinquents

gonadal diferentiation
GONADAL DIFERENTIATION

Kucinskas and Just, 2005

hohlweg s effekt
HOHLWEG´S EFFEKT

Kiss1/kisspeptin system

Kiss1 gene expression and

kisspeptin protein levels in

anteroventral periventricular

nucleus – higher levels

in females

Kauffman 2009

sigmund freud 1856 1939
SIGMUND FREUD1856 - 1939
  • THEORY OF UNCONSCIOUNESS
  • PSYCHOSEXUAL DEVELOPMENT
  • CHILDHOOD SEXUALITY
  • CONFLICTS, COMPLEXES
consequences of early stress and childhood maltreatment child sexual abuse

Consequences of early stress and childhood maltreatment (child sexual abuse)

…The major structural consequences of early stress include reduced size of the mid-portions of the corpus callosum and attenuated development of the left neocortex, hippocampus, and amygdala…

…Early stress alters the development of monoamine neurotransmitters and affects their degree of laterality…

Teicher et al., 2003

slide16

CUMMULATIVE FREQUENCY OF EXPERIENCES WITH FORCEFULL SEXUAL ACTIVITY174 female students and 137 male students of 1st. Medical School

%

age (years)

Raboch, 1996

plasticity of the brain
EVOLUTIONARY

REACTIVE

ADAPTIVE

REPARATIVE

SYNAPTIC LEVEL

LOCAL CIRCUITS

DISTANT CIRCUITS

PROLIFERATION

MIGRATION

DIFERENTIATION

CRITICAL (SENSITIVE) PERIODS

Plasticity of the brain
slide19

HIPPOCAMPUS AND DEPRESSION

Vaidya a Duman, 2001

neuroanatomical sex specific differences
Neuroanatomical sex-specific differences
  • MALE BRAIN CONTAINS ON AVERAGE 16% NEURONS MORE
  • MALE CORPUS CALLOSUM IS BIGGER
  • FEMALE TEMPORAL CORTEX HAS ON AVERAGE 11% GREATER DENSITY OF NEURONS
  • THE MOST SIGNIFICANT DIFFERENCES - HYPOTHALAMUS

Sickel a McCarthy, 2000

sexual diferentiation of the brain
Sexual diferentiation of the brain
  • HYPOTHALAMUS
  • SDN-POA (sexually dimorphic nucleus of praeoptic area) - rats
  • INAH 1,2,3,4 (interstitial nuclei of the anterior hypothalamus) – human beings
  • Bed nucleus of stria terminalis
volumes of bed nucleus of stria terminalis
VOLUMES OF BED NUCLEUS OF STRIA TERMINALIS

MTF-T – malet to female transsexuals

N=6

Zhou et al., 1995

criteria of sexual normality
Criteria of sexual „normality“
  • Adequate gender identity
  • PREFERENCE OF
  • Heterosexuality (?)
  • Mature object
  • Mutual contrived (voluntary)
  • Adequate interaction technique
  • Other…
f64 gender identity disorders
F64 Gender identity disorders
  • F64.0 Transsexualism
  • F64.1 Transvestitism of the double role
  • F64.2 Gender identity disorder in childhood
f66 mental and behavioral disorders connceted with the sexual development and orientation
F66 Mental and behavioral disorders connceted with the sexual development and orientation
  • F66.0 Sexual maturation disorder
  • F66.1 Ego-dystonic sexual orientation
  • F66.2 Sexual relationships disorder
f65 disorders of sexual preferences
F65 Disorders of sexual preferences

F65.0 – Fetishism

F65.1 – Transvestic fetishism

F65.2 – Exhibitionism

F65.3 – Voyerism

F65.4 – Pedophilia

F65.5 – Sexual sadism, masochism

F65.6 – Multiple disorders of sexual preferences

treatment of paraphilias
voluntary

involuntary

out-patient

in-patient

Psychotherapy

individual

group

CBT

Sociotherapy

Pharmacoterapy

(estrogens)

antiandrogens

gestagens

lithium

neuroleptics

LH-RH analogs

Operations (?)

hypothalamo-thomy

castration

Treatment of paraphilias